冠状动脉旁路移植术后早期新发心房颤动的临床特征及影响因素分析  

Clinical features and influencing factors for new-onset atrial fibrillation early after coronary artery bypass grafting

作　　者：韦亚林[1] 陈福芳 陈文胜[1] 关新强[1] 张燕春[1] 毛勇[1] 周亚雄[1] 罗伟[1] 张小鹏 吴向阳[1] WEI Yalin;CHEN Fufang;CHEN Wensheng;GUAN Xinqiang;ZHANG Yanchun;MAO Yong;ZHOU Yaxiong;LUO Wei;ZHANG Xiaopeng;WU Xiangyang(Department of Cardiac Surgery,Lanzhou University Second Hospital,Lanzhou,730000,P.R.China)

机构地区：[1]兰州大学第二医院心脏外科,兰州730000

出　　处：《中国胸心血管外科临床杂志》2021年第1期87-92,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨冠状动脉旁路移植术后新发心房颤动(房颤)的临床特征及影响因素。方法回顾性分析2012年1月至2019年1月在我院行冠状动脉旁路移植术的339例患者的临床资料,其中男267例、女72例,年龄37~83(58.03±8.90)岁。分析术后新发房颤的临床特征及影响因素。结果不停跳冠状动脉旁路移植(offpump coronary artery bypass grafting,OPCABG)患者共234例,术后新发房颤36例(15.4%),其中男性房颤发生率为16.1%,女性为12.5%。停跳冠状动脉旁路移植(coronary artery bypass grafting,CABG)患者共105例,术后出现新发房颤39例(37.1%),其中男性房颤发生率为40.7%,女性为25.0%。CABG术后新发房颤发生率明显高于OPCABG(37.1%vs.15.4%,P<0.05),但两组不同性别之间差异无统计学意义(P>0.05)。两种术式术后新发房颤发生率随着年龄增加而上升,最高年龄段为≥60岁(18.9%和45.8%),明显高于<45岁患者(P<0.05)。两种术式术后新发房颤的高发时间均为术后第2 d(即术后24~48 h),发作后持续1 d(24 h)的比例最高(P<0.05)。单因素和多因素logistic回归分析显示,高血压(OR=4.983,P=0.036)、频发房性期前收缩或房性心动过速(OR=17.682,P=0.002)、术后肌酸激酶同工酶MB(CKMB)(OR=0.152,P=0.042)、左房前后径(OR=17.614,P<0.001)和术前射血分数(OR=7.094,P=0.011)是OPCABG术后新发房颤的影响因素;而糖尿病(OR=11.631,P=0.020)、合并其它心脏畸形(OR=29.023,P=0.002)、频发室性期前收缩或室性心动过速(OR=0.047,P=0.001)和术后CKMB(OR=3.672,P=0.040)是CABG术后新发房颤的影响因素。结论CABG术后新发房颤发生率高于OPCABG,且都随着年龄的增加而逐渐升高,但这两种术式的新发房颤在不同性别之间差异无统计学意义。两种术式术后新发房颤的影响因素不同。Objective To investigate the clinical features and influencing factors for new-onset atrial fibrillation(AF)early after coronary artery bypass grafting.Methods The clinical data of 339 patients undergoing coronary artery bypass grafting in our hospital from January 2012 to January 2019 were retrospectively analyzed.There were 267 males and 72 females with an average age of 37-83(58.03±8.90)years.The clinical features and influencing factors for new-onset AF after surgery were investigated.Results There were 234 patients of off-pump coronary artery bypass grafting(OPCABG),with 36(15.4%)new-onset AF patients after operation,among whom 16.1%were males and 12.5%were females.There were 105 patients of on-pump coronary artery bypass grafting(CABG),with 39(37.1%)new-onset AF patients,among whom 40.7%were males and 25.0%were females.The incidence was higher after the CABG surgery than that after the OPCABG surgery(37.1%vs.15.4%,P<0.05).There was no statistical difference in the incidence rate between males and females(P>0.05).The incidence of new-onset AF after surgery was higher in≥60 years patients for both operations(18.9%and 45.8%),which was significantly higher than that in<45 years patients(P<0.05).For both operations,the incidence of new-onset AF after surgery was high on the second day(24-48 h)after surgery,and most of the AF lasted for1 day(P<0.05).The hypertension(OR=4.983,P=0.036),frequent premature atrial contraction or atrial tachycardia(OR=17.682,P=0.002),postoperative creatine kinase isoenzyme MB(CKMB)(OR=0.152,P=0.042),left anterior and posterior diameters(OR=17.614,P<0.001)and preoperative ejection fraction(OR=7.094,P=0.011)were influencing factors for new-onset AF after OPCABG.Diabetes(OR=11.631,P=0.020),other cardiac malformations(OR=29.023,P=0.002),frequent premature ventricular contraction or ventricular tachycardia(OR=0.047,P=0.001),and postoperative CKMB(OR=3.672,P=0.040)were influencing factors for new-onset AF after CABG.Conclusion The incidence of newonset AF after CABG is higher than that af

关 键 词：冠状动脉旁路移植术 新发房颤 临床特征 影响因素 外科手术 

分 类 号：R654.2[医药卫生—外科学] R541.75[医药卫生—临床医学]